Systems and methods for instrument based insertion architectures

ABSTRACT

Systems, devices and methods are provided in which an instrument can translate along an insertion axis. Rather than relying primarily on a robotic arm for instrument insertion, the instruments described herein have novel instrument based insertion architectures that allow portions of the instruments themselves to translate along an insertion axis. For example, an instrument can comprise a shaft, an end effector on a distal end of the shaft, and a handle coupled to the shaft. The architecture of the instrument allows the shaft to translate relative to the handle along an axis of insertion. The translation of the shaft does not interfere with other functions of the instrument, such as end effector actuation.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application is a continuation of application Ser. No. 16/215,208,filed Dec. 10, 2018, which claims the benefit of U.S. ProvisionalApplication No. 62/597,385, filed Dec. 11, 2017, each of which is herebyincorporated by reference in its entirety.

TECHNICAL FIELD

The systems and methods disclosed herein are directed to medicalinstruments, and more particularly to surgical tools for use in varioustypes of surgeries.

BACKGROUND

This description generally relates to medical instruments, andparticularly to surgical tools for use in various types of surgeries,including laparoscopic, endoscopic, endoluminal and open surgeries.

Robotic technologies have a range of applications. In particular,robotic arms help complete tasks that a human would normally perform.For example, factories use robotic arms to manufacture automobiles andconsumer electronics products. Additionally, scientific facilities userobotic arms to automate laboratory procedures such as transportingmicroplates. In the medical field, physicians have started using roboticarms to help perform surgical procedures.

In a surgical robotic system, a robotic arm is connected to aninstrument device manipulator, e.g., at the end of the robotic arm, andis capable of moving the instrument device manipulator into any positionwithin a defined work space. The instrument device manipulator can bedetachably coupled to a surgical tool, such as a steerable catheter forendoscopic applications or any of a variety of laparoscopic andendoluminal instruments. The instrument device manipulator impartsmotion from the robotic arm to control the position of the surgicaltool, and it may also activate controls on the instrument, such aspull-wires to steer a catheter. Additionally, the instrument devicemanipulator may be electrically and/or optically coupled to theinstrument to provide power, light, or control signals, and may receivedata from the instrument such as a video stream from a camera on theinstrument.

During use, a surgical tool is connected to the instrument devicemanipulator so that the instrument is away from a patient. The roboticarm then advances the instrument device manipulator and the instrumentconnected thereto towards a surgery site within the patient. In alaparoscopic procedure, the instrument is moved through a port in a bodywall of the patient. The robotic arm is capable of manipulating theinstrument in multiple degrees of freedom, including pitch, yaw andinsertion. Typically, a robotic arm provides all of these degrees offreedom.

With respect to insertion, a robotic arm typically has a linearinsertion axis to provide the insertion degree of freedom. Difficultiescan arise when the robotic arm is responsible for the linear insertionof an instrument. In particular, the mass of the robotic arm (alone orin combination with an instrument) can lead to a heavy swung mass andreduce performance at shallow insertion depths. In addition, reliance onthe robotic arm for insertion reduces the working space available for asurgeon or assistant during a robotic surgical procedure. Accordingly,there is a need to reduce reliance on the robotic arm when linearlyinserting an instrument.

SUMMARY

Embodiments of the application are directed to systems, devices andmethods that reduce reliance on a robotic arm when linearly inserting aninstrument. In particular, the systems, devices and methods describedherein relate to instruments having instrument based linear insertionarchitectures. For example, one or more instruments can be providedwherein a shaft of the instrument is capable of translation along anaxis of insertion, thereby reducing reliance on the robotic arm forlinear insertion. While in some embodiments, the robotic arm can stillbe used for linear insertion along with an instrument itself, in otherembodiments, this motion is eliminated, thereby reducing the overallprofile of the robot and minimizing swung mass at the end of thesurgical robot arm.

In some embodiments, a medical device comprises a shaft, an end effectorconnected to the shaft, and a handle coupled to the shaft. The handleincludes a first mechanical input and a second mechanical input. Thefirst mechanical input is configured to cause actuation of the endeffector, while the second mechanical input is configured to causetranslation of the shaft relative to the handle. The actuation of theend effector is performed via a first actuation mechanism that isdecoupled from a second actuation mechanism that causes the translationof the shaft relative to the handle. The first actuation mechanism caninclude a first cable that extends through a first set of pulleys,wherein manipulation of at least one pulley of the first set of pulleysvia the first mechanical input causes a change of length of the firstcable within the handle, thereby causing actuation of the end effector.The second actuation mechanism can include a second cable that engages aspool, wherein manipulation of the spool of the second set of pulleysvia the second mechanical input causes the shaft to translate relativeto the handle. The spool can be a capstan, such as a zero-walk capstan.The change of length of the first cable within the handle to causeactuation of the end effector is not affected by the second actuationmechanism that translates the shaft relative to the handle. In someinstances, the cable of the first actuation mechanism extends from theproximal portion of the shaft, through the first set of pulleys and tothe distal portion of the shaft. In other instances, the first actuationmechanism includes one or more cables that extend through a first set ofpulleys, and the second actuation mechanism includes one or more cablesand an insertion spool, wherein at least one or more cables of the firstactuation mechanism terminates on the insertion spool.

In some embodiments, a medical system comprises a base, a tool holdercoupled to the base, and an instrument. A robotic arm can be positionedbetween the base and the tool holder. The tool holder includes anattachment interface. The instrument comprises a shaft, an end effectorand a handle having a reciprocal interface for attachment to the toolholder. The handle further includes a first mechanical input and asecond mechanical input. The first mechanical input is configured tocause actuation of the end effector, while the second mechanical inputis configured to cause translation of the shaft relative to the handle.The actuation of the end effector is performed via a first actuationmechanism that is decoupled from a second actuation mechanism thatcauses the translation of the shaft relative to the handle. In someinstances, the first actuation mechanism includes a first cable thatextends through a first set of pulleys, wherein manipulation of at leastone pulley of the first set of pulleys via the first mechanical inputcauses a change of length of the first cable within the handle, therebycausing actuation of the end effector, and wherein the translation ofthe shaft relative to the handle is performed via the second actuationmechanism that includes a second cable that engages a spool, whereinmanipulation of the spool via the second mechanical input causes theshaft to translate relative to the handle.

In some embodiments, a surgical method comprises providing an instrumentconfigured for delivery through an incision or natural orifice of apatient to perform a surgical procedure at a surgical site. Theinstrument comprises a shaft, a handle coupled to the shaft, and an endeffector extending from the shaft. The shaft is capable of translationrelative to the handle. The actuation of the end effector is performedvia a first actuation mechanism that is decoupled from a secondactuation mechanism that causes the translation of the shaft relative tothe handle. In some instances, the instrument includes a first actuationmechanism for actuating the end effector and a second actuationmechanism for translating the shaft relative to the handle, wherein thefirst actuation mechanism comprises a first set of pulleys and a firstcable and the second actuation mechanism comprises a spool and a secondcable.

In some embodiments, a surgical method comprises delivering aninstrument through an incision or natural orifice of a patient toperform a surgical procedure at a surgical site. The instrumentcomprises a shaft, a handle coupled to the shaft, and an end effectorextending from the shaft. The shaft is capable of translation relativeto the handle. The actuation of the end effector is performed via afirst actuation mechanism that is decoupled from a second actuationmechanism that causes the translation of the shaft relative to thehandle. In some instances, the instrument includes a first actuationmechanism for actuating the end effector and a second actuationmechanism for translating the shaft relative to the handle, wherein thefirst actuation mechanism comprises a first set of pulleys and a firstcable and the second actuation mechanism comprises a spool and a secondcable.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A illustrates a surgical robotic system, according to oneembodiment.

FIG. 1B illustrates a surgical robotic system, according to analternative embodiment.

FIG. 2 illustrates a command console for a surgical robotic system,according to one embodiment.

FIG. 3 illustrates a perspective view of an instrument devicemanipulator for a surgical robotic system, according to one embodiment.

FIG. 4 illustrates a side view of the instrument device manipulator ofFIG. 3, according to one embodiment.

FIG. 5 illustrates a front-perspective exploded view of an examplesurgical tool secured to the instrument device manipulator of FIG. 3,according to one embodiment.

FIG. 6 illustrates a back-perspective exploded view of an examplesurgical tool secured to the instrument device manipulator of FIG. 3,according to one embodiment.

FIG. 7 illustrates a zoomed-in, perspective view of an actuationmechanism for engagement and disengagement of a surgical tool from asurgical tool holder, according to one embodiment.

FIGS. 8A and 8B illustrate a process of engaging and disengaging asurgical tool from a sterile adapter, according to one embodiment.

FIGS. 9A and 9B illustrate a process of engaging and disengaging asurgical tool from a sterile adapter, according to an additionalembodiment.

FIG. 10A illustrates a perspective view of a mechanism for rolling asurgical tool holder within an instrument device manipulator, accordingto one embodiment.

FIG. 10B illustrates a cross-sectional view of an instrument devicemanipulator, according to one embodiment.

FIGS. 10C and 10D illustrates partially exploded, perspective views ofthe internal components of an instrument device manipulator and certainelectrical components thereof, according to one embodiment.

FIG. 10E illustrates a zoomed-in, perspective view of electricalcomponents of an instrument device manipulator for roll indexing thesurgical tool holder, according to one embodiment.

FIG. 11 illustrates a side view of an instrument having an instrumentbased insertion architecture, according to one embodiment.

FIG. 12 illustrates a schematic diagram showing a first actuationmechanism for actuating an end effector, according to one embodiment.

FIG. 13 illustrates a zoomed-in side view of a first actuation mechanismof the instrument of FIG. 11, according to one embodiment.

FIG. 14 illustrates a zoomed-in perspective view of a first actuationmechanism of the instrument of FIG. 11, according to one embodiment.

FIG. 15 illustrates a view of a pulley and cable of the instrument ofFIG. 11, prior to actuation of the pulley, according to one embodiment.

FIG. 16 illustrates a view of a pulley and cable of the instrument ofFIG. 11, following actuation of the pulley, according to one embodiment.

FIG. 17 illustrates a side view of a second actuation mechanismincluding a spool for shaft translation, according to one embodiment.

FIG. 18 illustrates a perspective view of an alternative spool using asingle cable for shaft translation, according to one embodiment.

FIG. 19 illustrates a perspective view of an alternative spool usingmore than one cable for shaft translation, according to one embodiment.

FIG. 20 illustrates a front view of a handle including the spool of FIG.18, according to one embodiment.

FIG. 21 illustrates a schematic diagram showing an alternativearchitecture for actuating an end effector and shaft translation,according to one embodiment.

FIG. 22A illustrates a zoomed-in front view of an instrumentincorporating the alternative architecture for actuating an end effectorand shaft insertion of FIG. 21, according to one embodiment.

FIG. 22B illustrates a top perspective view of an instrumentincorporating the alternative architecture for actuating an end effectorand shaft insertion of FIG. 21, according to one embodiment.

FIG. 23 illustrates a top perspective view of a handle and shaft of aninstrument, according to one embodiment.

FIG. 24A illustrates a schematic view of a cross-section of aninstrument shaft utilizing the insertion architecture shown in FIG. 12,according to one embodiment.

FIG. 24B illustrates a schematic view of a cross-section of aninstrument shaft utilizing the insertion architecture shown in FIG. 21,according to one embodiment.

FIG. 25 illustrates a schematic diagram showing an architecture fordriving a knife in a vessel sealer, according to one embodiment.

FIG. 26 illustrates a schematic diagram showing an alternativearchitecture for driving a knife in a vessel sealer, according to oneembodiment.

FIG. 27 illustrates a schematic diagram showing yet another alternativearchitecture for driving a knife in a vessel sealer, according to oneembodiment.

FIG. 28 illustrates a schematic diagram showing an architecture formaking a rigid camera an insertion instrument, according to oneembodiment.

FIG. 29 shows a first insertion architecture that allows a camera to beseparated from an insertion handle, according to one embodiment.

FIGS. 30 and 31 show a second insertion architecture that allows acamera to be separated from an insertion handle, according to oneembodiment.

FIG. 32 illustrates a diagram showing an alternative architecture forshaft translation, according to another embodiment.

FIG. 33 shows a side cross-sectional view of an instrument havingmultiple seals to prevent air leakage from a patient.

FIG. 34 shows a front cross-sectional view of the instrument having themultiple seals.

The figures depict embodiments of the present invention for purposes ofillustration only. One skilled in the art will readily recognize fromthe following discussion that alternative embodiments of the structuresand methods illustrated herein may be employed without departing fromthe principles of the invention described herein.

DETAILED DESCRIPTION I. Surgical Robotic System

FIG. 1A illustrates an embodiment of a surgical robotic system 100. Thesurgical robotic system 100 includes a base 101 coupled to one or morerobotic arms, e.g., robotic arm 102. The base 101 is communicativelycoupled to a command console, which is further described herein withreference to FIG. 2. The base 101 can be positioned such that therobotic arm 102 has access to perform a surgical procedure on a patient,while a user such as a physician may control the surgical robotic system100 from the comfort of the command console. In some embodiments, thebase 101 may be coupled to a surgical operating table or bed forsupporting the patient. For example, in some embodiments, a base 101that is coupled to a robotic arm 102 can be coupled to a bed via one ormore rails that extend along the bed (as shown in FIG. 1B). Though notshown in FIG. 1A for purposes of clarity, in some embodiments, the base101 may include subsystems such as control electronics, pneumatics,power sources, optical sources, and the like. The robotic arm 102includes multiple arm segments 110 coupled at joints 111, which providesthe robotic arm 102 multiple degrees of freedom, e.g., seven degrees offreedom corresponding to seven arm segments. The base 101 may contain asource of power 112, pneumatic pressure 113, and control and sensorelectronics 114—including components such as a central processing unit,data bus, control circuitry, and memory—and related actuators such asmotors to move the robotic arm 102. The electronics 114 in the base 101may also process and transmit control signals communicated from thecommand console.

In some embodiments, the base 101 includes wheels 115 to transport thesurgical robotic system 100. Mobility of the surgical robotic system 100helps accommodate space constraints in a surgical operating room as wellas facilitate appropriate positioning and movement of surgicalequipment. Further, the mobility allows the robotic arms 102 to beconfigured such that the robotic arms 102 do not interfere with thepatient, physician, anesthesiologist, or any other equipment. Duringprocedures, a user may control the robotic arms 102 using controldevices such as the command console.

In some embodiments, the robotic arm 102 includes set up joints that usea combination of brakes and counter-balances to maintain a position ofthe robotic arm 102. The counter-balances may include gas springs orcoil springs. The brakes, e.g., fail safe brakes, may include mechanicaland/or electrical components. Further, the robotic arms 102 may begravity-assisted passive support type robotic arms.

Each robotic arm 102 may be coupled to an instrument device manipulator(IDM) 117 using a mechanism changer interface (MCI) 116. The IDM 117 canserve as a tool holder. In some embodiments, the IDM 117 can be removedand replaced with a different type of IDM, for example, a first type ofIDM that manipulates an endoscope can be replaced with a second type ofIDM that manipulates a laparoscope. The MCI 116 includes connectors totransfer pneumatic pressure, electrical power, electrical signals, andoptical signals from the robotic arm 102 to the IDM 117. The MCI 116 canbe a set screw or base plate connector. The IDM 117 manipulates surgicaltools such as the instrument 118 using techniques including directdrive, harmonic drive, geared drives, belts and pulleys, magneticdrives, and the like. The MCI 116 is interchangeable based on the typeof IDM 117 and can be customized for a certain type of surgicalprocedure. The robotic arm 102 can include joint level torque sensingand a wrist at a distal end.

The tool or instrument 118 can comprise a laparoscopic, endoscopicand/or endoluminal instrument that is capable of performing a procedureat a surgical site of a patient. In some embodiments, the instrument 118comprises a laparoscopic instrument insertable into an incision of apatient. The laparoscopic instrument can comprise a rigid, semi-rigid orflexible shaft. When designed for laparoscopy, the distal end of theshaft may be connected to an end effector that may comprise, forexample, a wrist, a grasper, scissors or other surgical tool. In someembodiments, the instrument 118 comprises an endoscopic surgical toolthat is inserted into the anatomy of a patient to capture images of theanatomy (e.g., body tissue). In some embodiments, the endoscopicinstrument comprises a tubular and flexible shaft. The endoscopeincludes one or more imaging devices (e.g., cameras or sensors) thatcapture the images. The imaging devices may include one or more opticalcomponents such as an optical fiber, fiber array, or lens. The opticalcomponents move along with the tip of the instrument 118 such thatmovement of the tip of the instrument 118 results in changes to theimages captured by the imaging devices. In some embodiments, theinstrument 118 comprises an endoluminal instrument insertable through anatural orifice of a patient, such as a bronchoscope or urethroscope.The endoluminal instrument can comprise a tubular and flexible shaft.When designed for endoluminal surgery, the distal end of the shaft maybe connected to an end effector that may comprise, for example, a wrist,a grasper, scissors, or other surgical tool.

In some embodiments, robotic arms 102 of the surgical robotic system 100manipulate the instrument 118 using elongate movement members. Theelongate movement members may include pull-wires, also referred to aspull or push wires, cables, fibers, or flexible shafts. For example, therobotic arms 102 actuate multiple pull-wires coupled to the instrument118 to deflect the tip of the instrument 118. The pull-wires may includeboth metallic and non-metallic materials such as stainless steel,Kevlar, tungsten, carbon fiber, and the like. In some embodiments, theinstrument 118 may exhibit nonlinear behavior in response to forcesapplied by the elongate movement members. The nonlinear behavior may bebased on stiffness and compressibility of the instrument 118, as well asvariability in slack or stiffness between different elongate movementmembers.

The surgical robotic system 100 includes a controller 120, for example,a computer processor. The controller 120 includes a calibration module125, image registration module 130, and a calibration store 135. Thecalibration module 125 can characterize the nonlinear behavior using amodel with piecewise linear responses along with parameters such asslopes, hystereses, and dead zone values. The surgical robotic system100 can more accurately control an endoscope 118 by determining accuratevalues of the parameters. In some embodiments, some or all functionalityof the controller 120 is performed outside the surgical robotic system100, for example, on another computer system or server communicativelycoupled to the surgical robotic system 100.

FIG. 1B illustrates a surgical robotic system, according to analternative embodiment. Like the embodiment of the surgical roboticsystem in FIG. 1A, the surgical robotic system in FIG. 1B includes oneor more robotic arms 102 having an IDM 117 and surgical tool orinstrument 118 attached thereto. In the present embodiment, the one ormore robotic arms 102 are attached to one or more adjustable rails 150coupled to a patient platform 160 in the form of a bed. In the presentembodiment, three robotic arms 102 are attached to an adjustable rail150 on a first side of the patient platform 160, while two robotic arms102 are attached to an adjustable rail 150 on a second side of thepatient platform 160, thereby providing a system with bilateral arms.

II. Command Console

FIG. 2 illustrates a command console 200 for a surgical robotic system100 according to one embodiment. The command console 200 includes aconsole base 201, display modules 202, e.g., monitors, and controlmodules, e.g., a keyboard 203 and joystick 204. In some embodiments, oneor more of the command module 200 functionality may be integrated into abase 101 of the surgical robotic system 100 or another systemcommunicatively coupled to the surgical robotic system 100. A user 205,e.g., a physician, remotely controls the surgical robotic system 100from an ergonomic position using the command console 200.

The console base 201 may include a central processing unit, a memoryunit, a data bus, and associated data communication ports that areresponsible for interpreting and processing signals such as cameraimagery and tracking sensor data, e.g., from the instrument 118 shown inFIG. 1A. In some embodiments, both the console base 201 and the base 101perform signal processing for load-balancing. The console base 201 mayalso process commands and instructions provided by the user 205 throughthe control modules 203 and 204. In addition to the keyboard 203 andjoystick 204 shown in FIG. 2, the control modules may include otherdevices, for example, computer mice, track pads, trackballs, controlpads, video game controllers, and sensors (e.g., motion sensors orcameras) that capture hand gestures and finger gestures.

The user 205 can control a surgical tool such as the instrument 118using the command console 200 in a velocity mode or position controlmode. In velocity mode, the user 205 directly controls pitch and yawmotion of a distal end of the instrument 118 based on direct manualcontrol using the control modules. For example, movement on the joystick204 may be mapped to yaw and pitch movement in the distal end of theinstrument 118. The joystick 204 can provide haptic feedback to the user205. For example, the joystick 204 vibrates to indicate that theinstrument 118 cannot further translate or rotate in a certaindirection. The command console 200 can also provide visual feedback(e.g., pop-up messages) and/or audio feedback (e.g., beeping) toindicate that the instrument 118 has reached maximum translation orrotation.

In position control mode, the command console 200 uses athree-dimensional (3D) map of a patient and pre-determined computermodels of the patient to control a surgical tool, e.g., the instrument118. The command console 200 provides control signals to robotic arms102 of the surgical robotic system 100 to manipulate the instrument 118to a target location. Due to the reliance on the 3D map, positioncontrol mode requires accurate mapping of the anatomy of the patient.

In some embodiments, users 205 can manually manipulate robotic arms 102of the surgical robotic system 100 without using the command console200. During setup in a surgical operating room, the users 205 may movethe robotic arms 102, instruments 118, and other surgical equipment toaccess a patient. The surgical robotic system 100 may rely on forcefeedback and inertia control from the users 205 to determine appropriateconfiguration of the robotic arms 102 and equipment.

The display modules 202 may include electronic monitors, virtual realityviewing devices, e.g., goggles or glasses, and/or other means of displaydevices. In some embodiments, the display modules 202 are integratedwith the control modules, for example, as a tablet device with atouchscreen. Further, the user 205 can both view data and input commandsto the surgical robotic system 100 using the integrated display modules202 and control modules.

The display modules 202 can display 3D images using a stereoscopicdevice, e.g., a visor or goggle. The 3D images provide an “endo view”(i.e., endoscopic view), which is a computer 3D model illustrating theanatomy of a patient. The “endo view” provides a virtual environment ofthe patient's interior and an expected location of an instrument 118inside the patient. A user 205 compares the “endo view” model to actualimages captured by a camera to help mentally orient and confirm that theinstrument 118 is in the correct—or approximately correct—locationwithin the patient. The “endo view” provides information aboutanatomical structures, e.g., the shape of an intestine or colon of thepatient, around the distal end of the instrument 118. The displaymodules 202 can simultaneously display the 3D model and computerizedtomography (CT) scans of the anatomy the around distal end of theinstrument 118. Further, the display modules 202 may overlaypre-determined optimal navigation paths of the instrument 118 on the 3Dmodel and CT scans.

In some embodiments, a model of the instrument 118 is displayed with the3D models to help indicate a status of a surgical procedure. Forexample, the CT scans identify a lesion in the anatomy where a biopsymay be necessary. During operation, the display modules 202 may show areference image captured by the instrument 118 corresponding to thecurrent location of the instrument 118. The display modules 202 mayautomatically display different views of the model of the instrument 118depending on user settings and a particular surgical procedure. Forexample, the display modules 202 show an overhead fluoroscopic view ofthe instrument 118 during a navigation step as the instrument 118approaches an operative region of a patient.

III. Instrument Device Manipulator

FIG. 3 illustrates a perspective view of an instrument devicemanipulator (IDM) 300 for a surgical robotic system, and FIG. 4 is aside view of the IDM 300, according to one embodiment. The IDM 300 isconfigured to attach a surgical tool or instrument to a robotic surgicalarm in a manner that allows the surgical tool to be continuously rotatedor “rolled” about an axis of the surgical tool. The IDM 300 includes abase 302 and a surgical tool holder assembly 304 coupled to the base.The surgical tool holder assembly 304 serves as a tool holder forholding an instrument 118. The surgical tool holder assembly 304 furtherincludes an outer housing 306, a surgical tool holder 308, an attachmentinterface 310, a passage 312, and a plurality of torque couplers 314. Insome embodiments, the passage 312 comprises a through bore that extendsfrom one face of the IDM 300 to an opposing face of the IDM 300. The IDM300 may be used with a variety of surgical tools (not shown in FIG. 3),which may include a handle and an elongated body (e.g., a shaft), andwhich may be for a laparoscope, an endoscope, or other types ofend-effectors of surgical tools.

The base 302 removably or fixedly mounts the IDM 300 to a surgicalrobotic arm of a surgical robotic system. In the embodiment of FIG. 3,the base 302 is fixedly attached to the outer housing 306 of thesurgical tool holder assembly 304. In alternative embodiments, the base302 may be structured to include a platform which is adapted torotatably receive the surgical tool holder 308 on the face opposite fromthe attachment interface 310. The platform may include a passage alignedwith the passage 312 to receive the elongated body of the surgical tooland, in some embodiments, an additional elongated body of a secondsurgical tool mounted coaxially with the first surgical tool.

The surgical tool holder assembly 304 is configured to secure a surgicaltool to the IDM 300 and rotate the surgical tool relative to the base302. Mechanical and electrical connections are provided from thesurgical arm to the base 302 and then to the surgical tool holderassembly 304 to rotate the surgical tool holder 308 relative to theouter housing 306 and to manipulate and/or deliver power and/or signalsfrom the surgical arm to the surgical tool holder 308 and ultimately tothe surgical tool. Signals may include signals for pneumatic pressure,electrical power, electrical signals, and/or optical signals.

The outer housing 306 provides support for the surgical tool holderassembly 304 with respect to the base 302. The outer housing 306 isfixedly attached to the base 302 such that it remains stationaryrelative to the base 302, while allowing the surgical tool holder 308 torotate freely relative to the outer housing 306. In the embodiment ofFIG. 3, the outer housing 306 is cylindrical in shape and fullycircumscribes the surgical tool holder 308. The outer housing 306 may becomposed of rigid materials (e.g., metals or hard plastics). Inalternative embodiments, the shape of the housing may vary.

The surgical tool holder 308 secures a surgical tool to the IDM 300 viathe attachment interface 310. The surgical tool holder 308 is capable ofrotating independent of the outer housing 306. The surgical tool holder308 rotates about a rotational axis 316, which co-axially aligns withthe elongated body of a surgical tool such that the surgical toolrotates with the surgical tool holder 308.

The attachment interface 310 is a face of the surgical tool holder 308that attaches to the surgical tool. The attachment interface 310includes a first portion of an attachment mechanism that reciprocallymates with a second portion of the attachment mechanism located on thesurgical tool, which will be discussed in greater detail with regards toFIGS. 8A and 8B. In some embodiments, the attachment interface 310comprises a plurality of torque couplers 314 that protrude outwards fromthe attachment interface 310 and engage with respective instrumentinputs on the surgical tool. In some embodiments, a surgical drape,coupled to a sterile adapter, may be used to create a sterile boundarybetween the IDM 300 and the surgical tool. In these embodiments, thesterile adapter may be positioned between the attachment interface 310and the surgical tool when the surgical tool is secured to the IDM 300such that the surgical drape separates the surgical tool and the patientfrom the IDM 300 and the surgical robotics system.

The passage 312 is configured to receive the elongated body of asurgical tool when the surgical tool is secured to the attachmentinterface 310. In the embodiment of FIG. 3, the passage 312 isco-axially aligned with the longitudinal axis of the elongated body ofthe surgical tool and the rotational axis 316 of the surgical toolholder 308. The passage 312 allows the elongated body of the surgicaltool to freely rotate within the passage 312. This configuration allowsthe surgical tool to be continuously rotated or rolled about therotational axis 316 in either direction with minimal or no restrictions.

The plurality of torque couplers 314 are configured to engage and drivethe components of the surgical tool when the surgical tool is secured tothe surgical tool holder 308. Each torque coupler 314 is inserted into arespective instrument input located on the surgical tool. The pluralityof torque couplers 314 may also serve to maintain rotational alignmentbetween the surgical tool and the surgical tool holder 308. Asillustrated in FIG. 3, each torque coupler 314 is shaped as acylindrical protrusion that protrudes outwards from the attachmentinterface 310. Notches 318 may be arranged along the outer surface areaof the cylindrical protrusion. In some embodiments, the arrangement ofthe notches 318 creates a spline interface. The instrument inputs on thesurgical tool are configured to have a complementary geometry to thetorque couplers 314. For example, while not shown in FIG. 3, theinstrument inputs of the surgical tool may be cylindrical in shape andhave a plurality of ridges that reciprocally mate with the plurality ofnotches 318 on each torque coupler 314 and thus impart a torque on thenotches 318. In alternate embodiments, the top face of the cylindricalprotrusion may include the plurality of notches 318 configured to matewith a plurality of ridges in respective instrument inputs. In thisconfiguration, each torque coupler 314 fully engages with its respectiveinstrument input.

Additionally, each torque coupler 314 may be coupled to a spring thatallows the torque coupler to translate. In the embodiment of FIG. 3, thespring causes each torque coupler 314 to be biased to spring outwardsaway from the attachment interface 310. The spring is configured tocreate translation in an axial direction, i.e., protract away from theattachment interface 310 and retract towards the surgical tool holder308. In some embodiments, each torque coupler 314 is capable ofpartially retracting into the surgical tool holder 308. In otherembodiments, each torque coupler 314 is capable of fully retracting intothe surgical tool holder 308 such that the effective height of eachtorque coupler is zero relative to the attachment interface 310. In theembodiment of FIG. 3, the translation of each torque coupler 314 isactuated by an actuation mechanism, which will be described in furtherdetail with regards to FIGS. 7-8. In various embodiments, each torquecoupler 314 may be coupled to a single spring, a plurality of springs,or a respective spring for each torque coupler.

In addition, each torque coupler 314 is driven by a respective actuatorthat causes the torque coupler to rotate in either direction. Thus, onceengaged with an instrument input, each torque coupler 314 is capable oftransmitting power to tighten or loosen pull-wires within a surgicaltool, thereby manipulating a surgical tool's end-effectors. In theembodiment of FIG. 3, the IDM 300 includes five torque couplers 314, butthe number may vary in other embodiments depending on the desired numberof degrees of freedom for a surgical tool's end-effectors. In someembodiments, a surgical drape, coupled to a sterile adapter, may be usedto create a sterile boundary between the IDM 300 and the surgical tool.In these embodiments, the sterile adapter may be positioned between theattachment interface 310 and the surgical tool when the surgical tool issecured to the IDM 300, and the sterile adapter may be configured totransmit power from each torque coupler 314 to the respective instrumentinput.

The embodiment of the IDM 300 illustrated in FIG. 3 may be used invarious configurations with a surgical robotic system. The desiredconfiguration may depend on the type of surgical procedure beingperformed on a patient or the type of surgical tool being used duringthe surgical procedure. For example, the desired configuration of theIDM 300 may be different for an endoscopic procedure than for alaparoscopic procedure.

In a first configuration, the IDM 300 may be removably or fixedlyattached to a surgical arm such that the attachment interface 310 isproximal to a patient during the surgical procedure. In thisconfiguration, hereinafter referred to as “front-mount configuration,”the surgical tool is secured to the IDM 300 on a side proximal to thepatient. A surgical tool for use with the front-mount configuration isstructured such that the elongated body of the surgical tool extendsfrom a side that is opposite of the attachment interface of the surgicaltool. As a surgical tool is removed from the IDM 300 in a front-mountconfiguration, the surgical tool will be removed in a proximal directionto the patient.

In a second configuration, the IDM 300 may be removably or fixedlyattached to a surgical arm such that the attachment interface 310 isdistal to a patient during the surgical procedure. In thisconfiguration, hereinafter referred to as “back-mount configuration,”the surgical tool is secured to the IDM 300 on a side distal to thepatient. A surgical tool for use with the back-mount configuration isstructured such that the elongated body of the surgical tool extendsfrom the attachment interface of the surgical tool. This configurationincreases patient safety during tool removal from the IDM 300. As asurgical tool is removed from the IDM 300 in a back-mount configuration,the surgical tool will be removed in a distal direction from thepatient.

In a third configuration, the IDM 300 may be removably or fixedlyattached to a surgical arm such that at least a portion of the surgicaltool is positioned above the IDM 300, similar to the configuration shownin FIG. 1A. In this configuration, hereinafter referred to as a “top” or“through” configuration, a shaft of the surgical tool extends downwardlythrough the IDM 300.

Certain configurations of a surgical tool may be structured such thatthe surgical tool can be used with an IDM in either a front-mountconfiguration or a back-mount configuration. In these configurations,the surgical tool includes an attachment interface on both ends of thesurgical tool. For some surgical procedures, the physician may decidethe configuration of the IDM depending on the type of surgical procedurebeing performed. For instance, the back-mount configuration may bebeneficial for laparoscopic procedures wherein laparoscopic tools may beespecially long relative to other surgical tools. As a surgical armmoves about during a surgical procedure, such as when a physiciandirects a distal end of the surgical tool to a remote location of apatient (e.g., a lung or blood vessel), the increased length oflaparoscopic tools causes the surgical arm to swing about a larger arc.Beneficially, the back-mount configuration decreases the effective toollength of the surgical tool by receiving a portion of the elongated bodythrough the passage 312 and thereby decreases the arc of motion requiredby the surgical arm to position the surgical tool.

FIGS. 5-6 illustrate perspective exploded views of an example surgicaltool 500 secured to the instrument device manipulator 300 of FIG. 3,according to one embodiment. The surgical tool 500 includes a housing502, an elongated body 504, and a plurality of instrument inputs 600. Aspreviously described, the elongated body 504 may be a laparoscope, anendoscope, or other surgical tool having end-effectors. As illustrated,the plurality of torque couplers 314 protrude outwards from theattachment interface 310 to engage with the instrument inputs 600 of thesurgical tool. The structure of the instrument inputs 600 can be seen inFIG. 6, wherein the instrument inputs 600 have corresponding geometry tothe torque couplers 314 to ensure secure surgical tool engagement.

During a surgical procedure, a surgical drape may be used to maintain asterile boundary between the IDM 300 and an outside environment (i.e.,an operating room). In the embodiments of FIGS. 5-6, the surgical drapecomprises a sterile adapter 506, a first protrusion 508, and a secondprotrusion 510. While not shown in FIGS. 5-6, a sterile sheet isconnected to the sterile adapter and the second protrusion and drapesaround the IDM 300 to create the sterile boundary.

The sterile adapter 506 is configured to create a sterile interfacebetween the IDM 300 and the surgical tool 500 when secured to the IDM300. In the embodiment of FIGS. 5-6, the sterile adapter 506 has adisk-like geometry that covers the attachment interface 310 of the IDM300. The sterile adapter 506 comprises a central hole 508 that isconfigured to receive the elongated body 504 of the surgical tool 500.In this configuration, the sterile adapter 506 is positioned between theattachment interface 310 and the surgical tool 500 when the surgicaltool 500 is secured to the IDM 300, creating the sterile boundarybetween the surgical tool 500 and the IDM 300 and allowing the elongatedbody 504 to pass through the passage 312. In certain embodiments, thesterile adapter 506 may be capable of rotating with the surgical toolholder 308, transmitting the rotational torque from the plurality oftorque couplers 314 to the surgical tool 500, passing electrical signalsbetween the IDM 300 and the surgical tool 500, or some combinationthereof.

In the embodiment of FIGS. 5-6, the sterile adapter 506 furthercomprises a plurality of couplers 512. A first side of a coupler 512 isconfigured to engage with a respective torque coupler 314 while a secondside of a coupler 512 is configured to engage with a respectiveinstrument input 600.

Similar to the structure of the plurality of torque couplers 314, eachcoupler 512 is structured as a cylindrical protrusion including aplurality of notches. Each side of the coupler 512 has complementarygeometry to fully engage with the respective torque coupler 314 and therespective instrument input 600. In some embodiments, the one or moreinstrument inputs 600 are referred to as mechanical inputs. Each coupler512 is configured to rotate in a clockwise or counter-clockwisedirection with the respective torque coupler 314. This configurationallows each coupler 512 to transfer rotational torque from the pluralityof torque couplers 314 of the IDM 300 to the plurality of instrumentinputs 600 of the surgical tool 500, and thus control the end-effectorsof the surgical tool 500.

The first protrusion 508 and the second protrusion 510 are configured topass through the passage 312 of the IDM 300 and mate with each otherinside the passage 312. Each protrusion 508, 510 is structured to allowthe elongated body 504 to pass through the protrusion and thus thepassage 312. The connection of the first protrusion 508 and the secondprotrusion 510 creates the sterile boundary between the IDM 300 and theoutside environment (i.e., an operating room).

IV. Surgical Tool Disengagement

FIG. 7 illustrates a zoomed-in, perspective view of an actuationmechanism for engagement and disengagement of a surgical tool 500 from asterile adapter 506 of a surgical drape, according to one embodiment.Due to the configuration of the IDM 300 as described with regards toFIG. 3, the axis of surgical tool insertion into the patient during asurgical procedure is the same as the axis of surgical tool removal. Toensure patient safety during surgical tool removal, the surgical tool500 can be de-articulated from the sterile adapter 506 and the IDM 300before removing the surgical tool 500. In the embodiment of FIG. 7, theplurality of couplers 512 are configured to translate in an axialdirection, i.e., protract away from and retract towards the sterileadapter 506. The translation of the plurality of couplers 512 isactuated by the actuation mechanism which ensures de-articulation of thesurgical tool 500 by disengaging the plurality of couplers 512 from therespective instrument inputs 600. The actuation mechanism includes awedge 702 and a pusher plate 704.

The wedge 702 is a structural component that activates the pusher plate704 during the process of surgical tool disengagement. In the embodimentof FIG. 7, the wedge 702 is located within the housing 502 of thesurgical tool 500 along the outer perimeter of the housing 502. Asillustrated, the wedge 702 is oriented such that contact with the pusherplate 704 causes the pusher plate 704 to depress into the sterileadapter 506 if the housing 502 of the surgical tool 500 is rotatedclockwise relative to the sterile adapter 506. In alternate embodiments,the wedge 702 may be configured such that the housing 502 of thesurgical tool 500 is rotated counter-clockwise rather than clockwise.Geometries other than a wedge may be employed, such as an arch-shapedramp, given that the structure is able to depress the pusher plate whenrotating.

The pusher plate 704 is an actuator that disengages the plurality ofcouplers 512 from the surgical tool 500. Similar to the plurality oftorque couplers 314, each of the couplers 512 may be coupled to one ormore springs that bias each coupler 512 to spring outwards away from thesterile adapter 506. The plurality of couplers 512 are furtherconfigured to translate in an axial direction, i.e., protract away fromand retract into the sterile adapter 506. The pusher plate 704 actuatesthe translational movement of the couplers 512. As the pusher plate 704is depressed by the wedge 702, the pusher plate 704 causes the spring orplurality of springs coupled to each coupler 512 to compress, resultingin the couplers 512 retracting into the sterile adapter 506. In theembodiment of FIG. 7, the pusher plate 704 is configured to causesimultaneous retraction of the plurality of couplers 512. Alternateembodiments may retract the couplers 512 in a specific sequence or arandom order. In the embodiment of FIG. 7, the pusher plate 704 causesthe plurality of couplers 512 to partially retract into the sterileadapter 506. This configuration allows a surgical tool 500 to bede-articulated from the sterile adapter 506 before the surgical tool 500is removed. This configuration also allows a user to de-articulate thesurgical tool 500 from the sterile adapter 506 at any desired timewithout removing the surgical tool 500. Alternate embodiments may fullyretract the plurality of couplers 512 into the sterile adapter 506 suchthat the effective height of each coupler 512 measured is zero. In someembodiments, the pusher plate 704 may cause the plurality of torquecouplers 314 to retract synchronously with the plurality of respectivecouplers 512.

FIGS. 8A and 8B illustrate a process of engaging and disengaging asurgical tool from a sterile adapter, according to one embodiment. FIG.8A illustrates a sterile adapter 506 and a surgical tool 500 in asecured position, such that the two components are secured together andthe plurality of couplers 512 are fully engaged with respectiveinstrument inputs 600 of the surgical tool 500. To achieve the securedposition as illustrated in FIG. 8A, the elongated body 504 (not shown)of the surgical tool 500 is passed through the central hole 508 (notshown) of the sterile adapter 506 until mating surfaces of the surgicaltool 500 and the sterile adapter 506 are in contact, and the surgicaltool 500 and the sterile adapter 506 are secured to each other by alatching mechanism. In the embodiments of FIGS. 8A and 8B, the latchingmechanism comprises a ledge 802 and a latch 804.

The ledge 802 is a structural component that secures the latch 804 inthe secured position. In the embodiment of FIG. 8A, the ledge 802 islocated within the housing 502 of the surgical tool 500 along the outerperimeter of the housing 502. As illustrated in FIG. 8A, the ledge 802is oriented such that it rests below a protrusion on the latch 804,preventing the latch 804 and thereby the sterile adapter 506 frompulling away from the surgical tool 500 due to the sprung-up nature ofthe plurality of couplers 512, as described with regards to FIG. 7.

The latch 804 is a structural component that mates with the ledge 802 inthe secured position. In the embodiment of FIG. 8A, the latch 804protrudes from the mating surface of the sterile adapter 506. The latch804 comprises a protrusion that is configured to rest against the ledge802 when the surgical tool 500 is secured to sterile adapter 506. In theembodiment of FIG. 8A, the housing 502 of the surgical tool 500 iscapable of rotating independent of the rest of the surgical tool 500.This configuration allows the housing 502 to rotate relative to thesterile adapter 506 such that the ledge 802 is secured against the latch804, thereby securing the surgical tool 500 to the sterile adapter 502.In the embodiment of FIG. 8A, the housing 502 is rotatedcounter-clockwise to achieve the secured position, but other embodimentsmay be configured for clockwise rotation. In alternate embodiments, theledge 802 and the latch 804 may have various geometries that lock thesterile adapter 506 and the surgical tool 500 in the secured position.

FIG. 8B illustrates the sterile adapter 506 and the surgical tool 500 inan unsecured position, in which the surgical tool 500 may be removedfrom the sterile adapter 506. As previously described, the housing 502of the surgical tool 500 is capable of rotating independent of the restof the surgical tool 500. This configuration allows the housing 502 torotate even while the plurality of couplers 512 are engaged with theinstrument inputs 600 of the surgical tool 500. To transition from thesecured position to the unsecured position, a user rotates the housing502 of the surgical tool 500 clockwise relative to the sterile adapter506. During this rotation, the wedge 702 contacts the pusher plate 704and progressively depresses the pusher plate 704 as it slides againstthe angled plane of the wedge 702, thereby causing the plurality ofcouplers 512 to retract into the sterile adapter 506 and disengage fromthe plurality of instrument inputs 600. Further rotation causes thelatch 804 to contact an axial cam 806, which is structured similar towedge 702. As the latch 804 contacts the axial cam 806 during rotation,the axial cam 806 causes the latch 804 to flex outwards away from thesurgical tool 500 such that the latch 804 is displaced from the ledge802. In this unsecured position, the plurality of couplers 512 areretracted, and the surgical tool 500 can be removed from the sterileadapter 506, in the embodiment of FIG. 8B. In other embodiments, theaxial cam 806 may have various geometries such that rotation causes thelatch 804 to flex outwards.

In alternate embodiments, the direction of rotation of the housing 502of the surgical tool 500 may be configured as counter-clockwise rotationto unsecure the latch 804 from the ledge 802. Additionally, alternateembodiments may include similar components but the location of thecomponents may be switched between the sterile adapter 506 and thesurgical tool 500. For example, the ledge 802 may be located on thesterile adapter 506 while the latch 804 may be located on the surgicaltool 500. In other embodiments, an outer portion of the sterile adapter506 may be rotatable relative to the plurality of couplers 512 ratherthan the housing 502 of the surgical tool 500. Alternate embodiments mayalso include a feature to lock the rotation of the housing 502 of thesurgical tool 502 when the housing 502 is fully rotated relative to theinstrument inputs 600. This configuration prevents rotation of thesurgical tool if the instrument inputs 600 have been de-articulated fromthe couplers 512. In some embodiments, the retraction and protraction ofthe couplers 512 may be coupled with a respective retraction andprotraction of the torque couplers 314, such that a coupler 512 engagedwith a torque coupler 314 will translate together.

FIGS. 9A and 9B illustrate a process of surgical tool engagement anddisengagement of a surgical tool from a sterile adapter, according toanother embodiment. In the embodiment of FIGS. 9A and 9B, a sterileadapter 900 may include an outer band 902 that secures the surgical tool904 to the sterile adapter 900. As illustrated in FIGS. 9A and 9B, thesurgical tool 902 comprises a ramp 906 on the outer surface of thehousing 908. The ramp 906 includes a notch 910 that is configured toreceive a circular protrusion 912, which is positioned on an innersurface of the outer band 902 of the sterile adapter 900. The outer band902 is capable of rotating independent of and relative to the sterileadapter 900 and the surgical tool 904. As the outer band 902 rotates ina first direction, the circular protrusion 912 glides up the surface ofthe ramp 906 until the circular protrusion 912 is nested within thenotch 910, thereby securing the sterile adapter 900 and the surgicaltool 904 together. Rotation of the outer band 902 in a second directioncauses the sterile adapter 900 and the surgical tool 904 to unsecurefrom each other. In certain embodiments, this mechanism may be coupledwith a de-articulation of the plurality of couplers 914 on the sterileadapter 900, as described with regards to FIGS. 7-8.

Alternative embodiments of surgical tool disengagement may includeadditional features, such as an impedance mode. With an impedance mode,the surgical robotics system may control whether the surgical tool canbe removed from the sterile adapter by a user. The user may initiate thedisengagement mechanism by rotating the outer housing of the surgicaltool and unsecuring the surgical tool from the sterile adapter, but thesurgical robotics system may not release the couplers from theinstrument inputs. Only once the surgical robotics system hastransitioned into the impedance mode are the couplers released and theuser can remove the surgical tool. An advantage of keeping the surgicaltool engaged is that the surgical robotics system can control theend-effectors of the surgical tool and position them for tool removalbefore the surgical tool is removed to minimize damage to the surgicaltool. To activate an impedance mode, the pusher plate 704 may have ahard-stop such that the pusher plate can be depressed up to a certaindistance. In some embodiments, the hard-stop of the pusher plate may beadjustable such that the hard-stop coincides with the maximum amount ofrotation of the housing of the surgical tool. Thus, once the fullrotation is reached, the hard-stop is also met by the pusher plate. Aplurality of sensors may detect these events and trigger the impedancemode.

Certain situations may require emergency tool removal during a surgicalprocedure in which the impedance mode may not be desirable. In someembodiments, the hard-stop of the pusher plate may have compliance, suchthat the hard-stop may yield in an emergency. The hard-stop of thepusher plate may be coupled to a spring, allowing the hard-stop to yieldin response to additional force. In other embodiments, the hard-stop ofthe pusher plate may be rigid such that emergency tool removal occurs byremoving the latch that secures the surgical tool to the sterileadapter.

V. Roll Mechanism

FIG. 10A illustrates a perspective view of a mechanism for rolling asurgical tool holder 308 within an instrument device manipulator 300,according to one embodiment. As illustrated in FIG. 10A, the attachmentinterface 310 is removed to expose the roll mechanism. This mechanismallows the surgical tool holder 308 to continuously rotate or “roll”about the rotational axis 316 in either direction. The roll mechanismcomprises a stator gear 1002 and a rotor gear 1004.

The stator gear 1002 is a stationary gear configured to mate with therotor gear 1004. In the embodiment of FIG. 10A, the stator gear 1002 isa ring-shaped gear comprising gear teeth along the inner circumferenceof the ring. The stator gear 1002 is fixedly attached to the outerhousing 306 behind the attachment interface 310. The stator gear 1002has the same pitch as the rotor gear 1004, such that the gear teeth ofthe stator gear 1002 are configured to mate with the gear teeth of therotor gear 1004. The stator gear 1002 may be composed of rigid materials(e.g., metals or hard plastics).

The rotor gear 1004 is a rotating gear configured to induce rotation ofthe surgical tool holder 308. As illustrated in FIG. 10A, the rotor gear1004 is a circular gear comprising gear teeth along its outercircumference. The rotor gear 1004 is positioned behind the attachmentinterface 310 and within the inner circumference of the stator gear 1002such that the gear teeth of the rotor gear 1004 mate with the gear teethof the stator gear. As previously described, the rotor gear 1004 and thestator gear 1002 have the same pitch. In the embodiment of FIG. 10A, therotor gear 1004 is coupled to a drive mechanism (e.g., a motor) thatcauses the rotor gear 1004 to rotate in a clockwise or counter-clockwisedirection. The drive mechanism may receive signals from an integratedcontroller within the surgical tool holder assembly 304. As the drivemechanism causes the rotor gear 1004 to rotate, the rotor gear 1004travels along the gear teeth of the stator gear 1002, thereby causingthe surgical tool holder 308 to rotate. In this configuration, the rotorgear 1004 is capable of continuously rotating in either direction andthus allows the surgical tool holder 308 to achieve infinite roll aboutthe rotational axis 316. Alternate embodiments may use similarmechanisms to allow for infinite roll, such as a configuration of a ringgear and a pinion gear.

FIG. 10B illustrates a cross-sectional view of an instrument devicemanipulator 300, according to one embodiment. As illustrated in FIB.10B, the roll mechanism is coupled with a plurality of bearing 1006. Abearing is a mechanical component that reduces friction between movingparts and facilitates rotation around a fixed axis. One bearing alonecan support the radial or torsional loading as the surgical tool holder308 rotates within the outer housing 306. In the embodiment of FIG. 10B,the IDM 300 includes two bearings 1006 a, 1006 b fixedly attached to thesurgical tool holder 308 such that a plurality of components (such asballs or cylinders) within the bearings 1006 contacts the outer housing306. A first bearing 1006 a is secured at a first end behind theattachment interface 310 and a second bearing 1006 b is secured at asecond end. This configuration improves rigidity and support between thefirst end and the second end of the surgical tool holder 308 as thesurgical tool holder 308 rotates within the outer housing 306. Alternateembodiments may include additional bearings that provide additionalsupport along the length of the surgical tool holder.

FIG. 10B also illustrates sealing components within the IDM 300,according to one embodiment. The IDM 300 comprises a plurality ofO-rings 1008 and a plurality of gaskets 1010 which are configured toseal a junction between two surfaces to prevent fluids from entering thejunction. In the embodiment of FIG. 10B, the IDM includes O-rings 1008a, 1008 b, 1008 c, 1008 d, 1008 e between junctions of the outer housingand gaskets 1010 a, 1010 b between junctions within the surgical toolholder 308. This configuration helps to maintain sterility of thecomponents within the IDM 300 during a surgical procedure. Gaskets andO-rings are typically composed of strong elastomeric materials (e.g.,rubber).

VI. Electrical Componentry

FIG. 10C illustrates a partially exploded, perspective view of theinternal components of an instrument device manipulator and certainelectrical components thereof, according to one embodiment. The internalcomponents of the surgical tool holder 308 include a plurality ofactuators 1102, a motor, a gearhead (not shown), a torque sensor (notshown), a torque sensor amplifier 1110, a slip ring 1112, a plurality ofencoder boards 1114, a plurality of motor power boards 1116, and anintegrated controller 1118.

The plurality of actuators 1102 drive the rotation of each of theplurality of torque couplers 314. In the embodiment of FIG. 10C, anactuator, such as 1102 a or 1102 b, is coupled to a torque coupler 314via a motor shaft. The motor shaft may be a keyed shaft such that itincludes a plurality of grooves to allow the motor shaft to securelymate to a torque coupler 314. The actuator 1102 causes the motor shaftto rotate in a clockwise or counter-clockwise direction, thereby causingthe respective torque coupler 314 to rotate in that direction. In someembodiments, the motor shaft may be torsionally rigid but springcompliant, allowing the motor shaft and thus the torque coupler 314 torotate and to translate in an axial direction. This configuration mayallow the plurality of torque couplers 314 to retract and protractwithin the surgical tool holder 308. Each actuator 1102 may receiveelectrical signals from the integrated controller 1118 indicating thedirection and amount to rotate the motor shaft. In the embodiment ofFIG. 10C, the surgical tool holder 308 includes five torque couplers 314and thus five actuators 1102.

The motor drives the rotation of the surgical tool holder 308 within theouter housing 306. The motor may be structurally equivalent to one ofthe actuators, except that it is coupled to the rotor gear 1004 andstator gear 1002 (see FIG. 10A) for rotating the surgical tool holder308 relative to the outer housing 306. The motor causes the rotor gear1004 to rotate in a clockwise or counter-clockwise direction, therebycausing the rotor gear 1004 to travel about the gear teeth of the statorgear 1002. This configuration allows the surgical tool holder 308 tocontinuously roll or rotate without being hindered by potential wind-upof cables or pull-wires. The motor may receive electrical signals fromthe integrated controller 1118 indicating the direction and amount torotate the motor shaft.

The gearhead controls the amount of torque delivered to the surgicaltool 500. For example, the gearhead may increase the amount of torquedelivered to the instrument inputs 600 of the surgical tool 500.Alternate embodiments may be configured such that the gearhead decreasesthe amount of torque delivered to the instrument inputs 600.

The torque sensor measures the amount of torque produced on the rotatingsurgical tool holder 308. In the embodiment shown in FIG. 10C, thetorque sensor is capable of measuring torque in the clockwise and thecounter-clockwise direction. The torque measurements may be used tomaintain a specific amount of tension in a plurality of pull-wires of asurgical tool. For instance, some embodiments of the surgical roboticssystem may have an auto-tensioning feature, wherein, upon powering onthe surgical robotics system or engaging a surgical tool with an IDM,the tension on the pull-wires of the surgical tool will be pre-loaded.The amount of tension on each pull-wire may reach a threshold amountsuch that the pull-wires are tensioned just enough to be taut. Thetorque sensor amplifier 1110 comprises circuitry for amplifying thesignal that measures the amount of torque produced on the rotatingsurgical tool holder 308. In some embodiments, the torque sensor ismounted to the motor.

The slip ring 1112 enables the transfer of electrical power and signalsfrom a stationary structure to a rotating structure. In the embodimentof FIG. 10C, the slip ring 1112 is structured as a ring including acentral hole that is configured to align with the passage 312 of thesurgical tool holder 308, as is also shown in an additional perspectiveview of the slip ring 1112 in FIG. 10D. A first side of the slip ring1112 includes a plurality of concentric grooves 1120 while a second sideof the slip ring 1112 includes a plurality of electrical components forthe electrical connections provided from the surgical arm and the base302, as described with regards to FIG. 3. The slip ring 1112 is securedto the outer housing 306 of the surgical tool holder 308 at a specificdistance from the outer housing 306 to allocate space for theseelectrical connections. The plurality of concentric grooves 1120 areconfigured to mate with a plurality of brushes 1122 attached to theintegrated controller. The contact between the grooves 1120 and thebrushes 1122 enables the transfer of electrical power and signals fromthe surgical arm and base to the surgical tool holder.

The plurality of encoder boards 1114 read and process the signalsreceived through the slip ring from the surgical robotic system. Signalsreceived from the surgical robotic system may include signals indicatingthe amount and direction of rotation of the surgical tool, signalsindicating the amount and direction of rotation of the surgical tool'send-effectors and/or wrist, signals operating a light source on thesurgical tool, signals operating a video or imaging device on thesurgical tool, and other signals operating various functionalities ofthe surgical tool. The configuration of the encoder boards 1114 allowsthe entire signal processing to be performed completely in the surgicaltool holder 308. The plurality of motor power boards 1116 each comprisescircuitry for providing power to the motors.

The integrated controller 1118 is the computing device within thesurgical tool holder 308. In the embodiment of FIG. 10C, the integratedcontroller 1118 is structured as a ring including a central hole that isconfigured to align with the passage 312 of the surgical tool holder308. The integrated controller 1118 includes a plurality of brushes 1122on a first side of the integrated controller 1118. The brushes 1122contact the slip ring 1112 and receive signals that are delivered fromthe surgical robotics system through the surgical arm, the base 302, andfinally through the slip ring 1112 to the integrated controller 1118. Asa result of the received signals, the integrated controller 1118 isconfigured to send various signals to respective components within thesurgical tool holder 308. In some embodiments, the functions of theencoder boards 1114 and the integrated controller 1118 may bedistributed in a different manner than is described here, such that theencoder boards 1114 and the integrated controller 1118 may perform thesame functions or some combination thereof.

FIG. 10D illustrates a partially exploded, perspective view of theinternal components of an instrument device manipulator and certainelectrical components thereof, according to one embodiment. Theembodiment of FIG. 10D includes two encoder boards 1114 a and 1114 b, atorque sensor amplifier 1110, and three motor power boards 1116 a, 1116b, and 1116 c. These components are secured to the integrated controller1118 and protrude outwards, extending perpendicularly from theintegrated controller 1118. This configuration provides room for theplurality of actuators 1102 and motor to be positioned within theelectrical boards.

As discussed with regards to FIG. 10C, the slip ring 1112 is secured ata specific distance from the outer housing 306. To ensure correct spaceallocation between the slip ring 1112 and the outer housing 306 for theelectrical connections from the surgical arm and base 302 to the slipring 1112, in the embodiment of FIG. 10D, the slip ring 1112 issupported by a plurality of alignment pins, a plurality of coil springs,and a shim. The slip ring 1112 includes a hole 1124 on each side of thecenter hole of the slip ring 1112 that is configured to accept a firstside of an alignment pin while a second side of the alignment pin isinserted into a respective hole in the outer housing 306. The alignmentpins may be composed of rigid materials (e.g., metal or hard plastics).The plurality of coil springs is secured around the center of the slipring 1112 and configured to bridge the space and maintain contactbetween the slip ring 1112 and the outer housing 306. The coil springsmay beneficially absorb any impact to the IDM 300. The shim isring-shaped spacer that is positioned around the center hole of the slipring 1112 to add further support between the slip ring 1112 and theouter housing 306. In addition, these components provide stability tothe slip ring 1112 as the plurality of brushes 1122 on the integratedcontroller 1118 contact and rotate against the plurality of concentricgrooves 1120. In alternate embodiments, the number of alignment pins,coil springs, and shims may vary until the desired support between theslip ring 1112 and the outer housing 306 is achieved.

FIG. 10E illustrates a zoomed-in, perspective view of electricalcomponents of an instrument device manipulator 300 for roll indexing thesurgical tool holder 308, according to one embodiment. Roll indexingmonitors the position of the surgical tool holder 308 relative to theouter housing 306 such that the position and orientation of the surgicaltool 500 is continuously known by the surgical robotics system. Theembodiment of FIG. 10E includes a micro switch 1202 and a boss 1204. Themicro switch 1202 and the boss 1204 are secured within the surgical toolholder 308. The boss 1204 is a structure on the outer housing 306 thatis configured to contact the micro switch 1202 as the surgical toolholder 308 rotates, thus activating the micro switch each time there iscontact with the boss 1204. In the embodiment of FIG. 10E, there is oneboss 1204 that serves as a single reference point for the micro switch1202.

VII. Instruments Having Instrument Based Insertion Architectures

Various tools or instruments can attach to the IDM 300, includinginstruments used for laparoscopic, endoscopic and endoluminal surgery.The instruments described herein are particularly novel, as they includeinstrument based insertion architectures that reduce the reliance onrobotic arms for insertion. In other words, insertion of an instrument(e.g., towards a surgical site) can be facilitated by the design andarchitecture of the instrument. For example, in some embodiments,wherein an instrument comprises an elongated shaft and a handle, thearchitecture of the instrument enables the elongated shaft to translaterelative to the handle along an axis of insertion.

The instruments described herein incorporate instrument based insertionarchitectures that alleviate many issues. Instruments that do notincorporate an instrument based insertion architecture rely on a roboticarm and its IDM for insertion. In this arrangement, to achieveinstrument insertion, the IDM may need to be moved in and out, thereforerequiring additional motor power and arm link size for moving theadditional mass in a controlled manner. In addition, the larger volumecreates a much larger swept volume that can result in collisions duringoperation. By incorporating instrument based insertion architectures,the instruments described herein typically have a reduced swung mass, asthe instrument itself (e.g., its shaft) moves along an insertion axiswith less reliance on the robotic arm.

Some embodiments of the instruments described herein may have novelinstrument based insertion architectures that not only allow forinsertion of the instrument, but also allow an end effector of theinstrument to actuate without interference. For example, in someembodiments, an instrument comprises a first actuation mechanism foractuating an end effector and a second actuation mechanism for causingtranslation of a portion of the instrument (e.g., a shaft) along an axisof insertion. The first actuation mechanism is advantageously decoupledfrom the second actuation mechanism such that the actuation of the endeffector is not affected by the insertion of the instrument, and viceversa.

FIG. 11 illustrates a side view of an instrument having an instrumentbased insertion architecture, according to one embodiment. The designand architecture of the instrument 1200 enables the instrument (e.g.,its shaft) to translate along an insertion axis with less reliance onmovement of a robotic arm for insertion.

The instrument 1200 comprises an elongated shaft 1202, an end effector1212 connected to the shaft 1202, and a handle 1220 coupled to the shaft1202. The elongated shaft 1202 comprises a tubular member having aproximal portion 1204 and a distal portion 1206. The elongated shaft1202 comprises one or more channels or grooves 1208 along its outersurface. The grooves 1208, which are most visible in the cross-sectionalview of the shaft 1202, are configured to receive one or more wires orcables 1230 therethrough. One or more cables 1230 thus run along anouter surface of the elongated shaft 1202. In other embodiments, cables1230 can also run through the shaft 1202, as shown in the schematicdrawing in FIG. 21. In some embodiments, cables 1230 that run throughthe shaft 1202 are not exposed. In some embodiments, manipulation of theone or more of these cables 1230 (e.g., via the IDM 300) results inactuation of the end effector 1212.

The end effector 1212 comprises one or more laparoscopic, endoscopic orendoluminal components designed to provide an effect to a surgical site.For example, the end effector 1212 can comprise a wrist, grasper, tines,forceps, scissors, or clamp. In the present embodiment shown in FIG. 11,one or more of the cables 1230 that extend along the grooves 1208 on theouter surface of the shaft 1202 actuate the end effector 1212. The oneor more cables 1230 extend from a proximal portion 1204 of the shaft1202, through the handle 1220 and toward a distal portion 1206 of theshaft 1202, where they actuate the end effector 1212.

The instrument handle 1220, which may also be referred to as aninstrument base, may generally comprise an attachment interface 1222having one or more mechanical inputs 1224, e.g., receptacles, pulleys orspools, that are designed to be reciprocally mated with one or moretorque couplers 314 on an attachment interface 310 of the IDM 300 (shownin FIG. 3). The attachment interface 1222 is capable of attaching to anIDM 300 via front-mount, back-mount and/or top mount. When physicallyconnected, latched, and/or coupled, the mated mechanical inputs 1224 ofthe instrument handle 1220 may share axes of rotation with the torquecouplers 314 of the IDM 300, thereby allowing the transfer of torquefrom the IDM 300 to the instrument handle 1220. In some embodiments, thetorque couplers 314 may comprise splines that are designed to mate withreceptacles on the mechanical inputs. Cables 1230 that actuate the endeffector 1212 engage the receptacles, pulleys or spools of the handle1220, such that the transfer of torque from the IDM 300 to theinstrument handle 1220 results in actuation of the end effector.

Some embodiments of the instrument 1200 comprise a first actuationmechanism that controls actuation of the end effector 1212. Anembodiment of such a first actuation mechanism is schematicallyillustrated in FIG. 12. In addition, the instrument 1200 includes asecond actuation mechanism that enables the shaft 1202 to translaterelative to the handle 1220 along an axis of insertion. An embodiment ofsuch a second actuation mechanism is shown in FIG. 17. Advantageously,the first actuation mechanism is decoupled from the second actuationmechanism, such that actuation of the end effector 1212 is not affectedby the translation of the shaft 1202, and vice versa. Embodiments of thefirst and second actuation mechanisms that can be incorporated into atool or instrument 1200 are described in more detail below with respectto FIGS. 12-20.

FIG. 12 illustrates a schematic diagram showing a first actuationmechanism for actuating an end effector, according to one embodiment. Insome embodiments, the first actuation mechanism provides N+1 wristmotion, wherein N is the number of degrees of freedom provided by N+1cables. The first actuation mechanism for actuating the end effector1212 comprises at least one cable or cable segment 1230 a that extendsthrough at least one set of pulleys 1250. In the present embodiment, afirst cable or cable segment 1230 a extends through pulley members 1250a, 1250 b, 1250 c, while a second cable or cable segment 1230 a extendsthrough pulley members 1250 d, 1250 e, 1250 f. The at least one cable1230 a is grounded at or near the proximal end 1205 of the shaft 1202,then extends through the at least one set of pulleys 1250 (which arelocated within the handle 1220), before terminating at the end effector1212. Cable total path length is kept constant by grounding each cable1230 a at or near the proximal end 1205 of the shaft 1202, and relativelength changes are made by moving pulleys (e.g., pulley members 1250 band 1250 e) relative to each other (see arrows), thereby enablingactuation of the end effector 1212. In some embodiments, the pulleys canbe moved via linear or rotary motion of corresponding mechanical inputs1224. This first actuation mechanism advantageously permits freemovement of the instrument shaft 1202 relative to the actuation pulleys1250 (which will be accomplished by a second actuation mechanismdescribed below), thereby allowing an additional cable to be included topermit insertion and retraction of the instrument shaft 1202 at the sametime as end effector 1212 actuation.

FIG. 13 illustrates a zoomed-in side view of a first actuation mechanismof the instrument of FIG. 11, according to one embodiment. The firstactuation mechanism corresponds with the schematic diagram shown in FIG.12 and is designed to cause actuation of the end effector 1212, whilepermitting a separate second actuation mechanism to translate the shaft1202 relative to the handle 1220. As shown in FIG. 13, the handle 1220includes a set of bearings, spools, pulleys or pulley members 1250 a,1250 b, 1250 c, 1250 d, 1250 e (wherein pulleys 1250 a, 1250 b, 1250 ccorrespond to the same set of pulleys in FIG. 12). A cable 1230 aextends through the pulleys 1250 a, 1250 d, 1250 b, 1250 e, 1250 c.Manipulation of a mechanical input (identified as 1224′ in FIG. 13)causes rotary motion of the pulleys 1250 d, 1250 b, 1250 e. The rotarymotion of the pulleys 1250 d, 1250 b, 1250 e changes the amount of cable1230 that is received in the handle 1220, thereby actuating the endeffector. The effect of the rotary motion of the pulleys on the cable1230 a is shown in FIGS. 15 and 16. Depending on the direction of therotary motion, the pulleys 1250 d, 1250 e can either wound or “take up”cable 1230 in the handle 1220, or can unwound and “give out” cable 1230a in the handle 1220. Either way, the length of the cable 1230 a changeswithin the handle 1220, thereby causing actuation of the end effector1212. While the embodiment in FIG. 13 depicts a pulley system that ismodified by rotary motion, in other embodiments, the pulley system canbe modified by linear and/or rotary motion. In addition, one skilled inthe art will appreciate that a change in length in the amount of cable1230 a in the handle 1220 can also change cable tension.

FIG. 14 illustrates a zoomed-in perspective view of a first actuationmechanism of the instrument of FIG. 11, according to one embodiment.From this view, one can see different details of the pulleys 1250 a-eincluding the spools of the pulleys 1250 a, 1250 c.

FIGS. 15 and 16 illustrate a front view of a pulley member 1250 e andcable of the instrument of FIG. 11, before and after actuation of thepulley member, according to one embodiment. Applying torque on themechanical input 1224′ rotates pulleys 1250 e, 1250 b and 1250 d. Asshown in FIG. 15, before actuation of the pulley 1250 e, cable 1230 acan run along one side of the pulley 1250 e. As shown in FIG. 16, afteractuation of the pulley 1250 e, the cable 1230 a is then wound and takenup by the pulley, thereby increasing the amount of cable 1230 a withinthe handle 1220 to cause actuation of an end effector.

While embodiments in FIGS. 11-16 disclose one or more pulleys mounted ona rotary axis to change relative cable length, in other embodiments,mounting a pulley on a lever, gear or track based system to adjustlocation are additional options. In addition, ball spline rotary shaftsthat travel down a length of a tool could also be used to transmitforces in a mechanically remote way.

FIG. 17 illustrates a side view of a second actuation mechanismincluding a spool for shaft translation, according to one embodiment.The second actuation mechanism is designed to translate the shaft 1202relative to the handle 1220 along an axis of insertion Like the firstactuation mechanism that actuates the end effector 1212, the secondactuation mechanism can also be incorporated within the handle 1220.

The second actuation mechanism comprises a cable or cable segment 1230 bthat engages a set of spools 1270 a, 1270 b, 1270 c, 1270 d. One end ofthe cable 1230 b can be attached at or near a proximal end 1205 of theshaft 1202, while the other end of the cable 1230 b can be attached ator near a distal end 1207 of the shaft 1202. The cable 1230 b extendsthrough the set of spools 1270 a, 1270 b, 1270 c, of which spool 1270 bis a capstan. Rotating a mechanical input of the handle 1220 causesrotation of the capstan, thereby driving cable 1230 b in and out of thecapstan. As cable 1230 b is driven in and out of the capstan, thiscauses the shaft 1202 to translate relative to the handle 1220.Advantageously, by applying adequate pre-tension to the cable 1230 bthat is attached at both the proximal and distal end of the shaft 1202,frictional force can be used to drive the cable 1230 b in and out,thereby moving the shaft 1202 relative to the handle 1220 withoutslipping.

In the present embodiment, the capstan 1270 b comprises a zero-walkcapstan. In other embodiments, such as shown in FIGS. 18 and 19, acapstan can be incorporated into the handle 1220 that can allow forcable walk. The zero-walk capstan architecture helps to manage multiplewraps of cable 1230 b around the capstan 1270 b without a helix angle onthe groove to prevent the cable walk across the capstan 1270 b, whichcould affect overall path length and change tension in the cable. Byplacing an additional pulley 1270 d on an incline next to the capstan1270 b, a redirect to a parallel path on the capstan 1270 b can beachieved, resulting in no walking action of the cable 1230 b on thecapstan 1270 b.

FIGS. 18 and 19 present alternative embodiments to the zero-walk capstanshown in FIG. 17. In these embodiments, the capstan that drives shaftinsertion is an enlarged capstan 1270 e that can be incorporated intothe architecture of the second actuation mechanism. With a large enoughdrive capstan 1270 e and a small enough insertion stroke, the number ofrotations of the capstan is small. For example, with a 22 mm drivecapstan 1270 e and a 350 mm insertion stroke, the number of rotations ofthe capstan 1270 e for full insertion range is 5 rotations. If thedistance that the cable goes to is large enough compared to the cablewalk range of the capstan 1270 e, the amount of fleet angle on the cableand path length change during insertion is small enough to benegligible. In some embodiments, the fleet angle can be between +/−2degrees.

FIG. 18 illustrates a perspective view of an alternative spool using asingle cable for shaft translation, according to one embodiment. Thealternative spool comprises an enlarged capstan 1270 e which is engagedby a single cable 1230 b. In this embodiment, to actuate drive shaftinsertion, the single cable 1230 b has a large enough wrap angle to haveenough capstan friction to drive. In some embodiments, the single cable1230 b is continuous and wraps around the capstan 1270 e multiple times(e.g., 3, 4 or more times) to have a large enough wrap angle to drivethe capstan and insertion.

FIG. 19 illustrates a perspective view of an alternative spool usingmore than one cable for shaft translation, according to one embodiment.The alternative spool comprises an enlarged capstan 1270 e which isengaged by two separate segments 1230 b′, 1230 b″ of a single cable 1230b. Each of the segments 1230 b′, 1230 b″ terminates on the capstan 1270e. Unlike the embodiment in FIG. 18, the present embodiment does notrely on capstan friction to drive shaft insertion. In this embodiment,the cable 1230 b is helixed to the outsides and then terminated to thespool at both the top and bottom. An advantage of the double terminationapproach shown in FIG. 19 is that it is resilient to loss of cabletension. As the double termination approach relies on a positiveengagement rather than friction, slip cannot happen.

FIG. 20 illustrates a front view of a handle including the spool of FIG.18, according to one embodiment. From this view, one can see onepossible position of the spool (e.g., the capstan 1270 e) within thehandle 1220. Advantageously, additional spools and pulleys can beprovided within the handle 1220 to actuate the end effector 1212. Forexample, a pulley system for end effector actuation as represented inFIG. 12 can be incorporated into the handle in FIG. 20. Accordingly, thehandle 1220 can incorporate multiple mechanisms for both end effectoractuation and/or drive insertion. As shown in FIG. 20, the one or morepulleys guiding the cable 1230 onto the capstan 1270 e are situatedacross the handle to increase cable distance. If the distance that thecable goes to is large enough compared to the cable walk range of thecapstan 1270 e, the amount of fleet angle on the cable and path lengthchange during insertion is small enough to be negligible. In someembodiments, it is possible to have a traditional helix capstan and keepthe length change and fleet angle to a minimum.

FIG. 21 illustrates a schematic diagram showing an alternativearchitecture for actuating an end effector and shaft insertion,according to one embodiment. The architecture incorporates a firstactuation mechanism for actuating an end effector and a second actuationmechanism for shaft insertion Like prior embodiments, the firstactuation mechanism and the second actuation mechanism are decoupled,such that actuation of the end effector does not impact shaft insertion,and vice versa. However, in the present embodiment, the first actuationmechanism comprises one or more cables for actuating an end effectorthat terminate at an insertion spool (which is also used as part of thesecond actuation mechanism for shaft insertion), rather than terminatingon the proximal and distal portions of the shaft as in the embodiment inFIG. 12. As a result of this architecture, during shaft insertion via asecond actuation mechanism, one or more cables that are wound by theinsertion spool are substantially counterbalanced by a length of one ormore cables (used in a first actuation mechanism to actuate an endeffector) that are unwound by the insertion spool. During end effectoractuation via a first actuation mechanism, one is trading off the pathlengths of the cables coming off of the insertion spool.

As shown in FIG. 21, the alternative architecture for end effectoractuation and shaft insertion comprises a shaft 1302 having a proximalportion 1304 and a distal portion 1306 where an end effector is located.One or more spools 1370 a, 1370 b, 1370 c, 1370 d, 1370 e (which arepart of a handle) are positioned about the shaft 1302. Spool 1370 ccomprises an insertion spool. Rotation of the insertion spool 1370 c ina first direction causes shaft translation relative to the handle in afirst direction (e.g., in a direction of insertion), while rotation ofthe insertion spool 1370 c in a second direction causes shafttranslation relative to the handle in a second direction (e.g., in adirection of retraction). One or more cables or cable segments 1330 aterminate to an end effector (e.g., a wrist) on one end and an insertionspool on the other. One or more additional cables or cable segments 1330b also begin at the insertion spool 1370 c before terminating at, nearor towards a distal portion 1306 of the shaft 1302.

In the present embodiment, a first actuation mechanism is providedwherein manipulation of one or more spools (e.g., spools 1370 a, 1370 d)via linear or rotary movement causes a change of length of the one ormore cables 1330 a within the handle. In some embodiments, the change oflength of the one or more cables 1330 a within the handle can include achange of the path length of one or more cables or cable segments withinthe handle. In this first actuation mechanism, the one or more cables1330 a can be considered “end effector” cables. Any change in length ofthe one or more cables 1330 a in the handle that causes actuation of theend effector is counterbalanced by a length of the one or more cables1330 b.

In the present embodiment, a second actuation mechanism is providedwherein manipulation of the insertion spool 1370 c via linear or rotarymovement causes a change of length of the one or more cables 1330 bwithin the handle. In this second actuation mechanism, the one or morecables 1330 b can be considered “insertion” cables. Any change in lengthof the one or more cables 1330 b in the handle that causes shaftinsertion or retraction is counterbalanced by a length of the one ormore cables 1330 a. Under insertion and retraction, tension ismaintained because equal amounts of the one or more end effector cables1330 a are being paid out as the one or more insertion cables 1330 b arebeing taken up. The relative path length of the one or more end effectorcables 1330 a remains unchanged, so the end effector does not move underinsertion.

FIG. 22A illustrates a zoomed-in front view of an instrumentincorporating the alternative architecture for actuating an end effectorand shaft insertion of FIG. 21, according to one embodiment. FIG. 22Billustrates a top perspective view of the instrument incorporating thealternative architecture for actuating an end effector and shaftinsertion of FIG. 21. The instrument 1300 incorporates the first andsecond actuation mechanism shown in FIG. 21, and includes a handle 1320comprising one or more mechanical inputs 1324, each corresponding to oneor more spools 1370 a-e, wherein at least one of the spools (1370 c)comprises an insertion spool. One or more cables or cable segments 1330a′, 1330 a″, 1330 a′″ and 1330 a″″, each corresponding to a separatemechanical input 1324, terminate at the drive spool 1370 c. Each ofthese cables 1330 a′, 1330 a″, 1330 a′″ and 1330 a″″ can engage with oneor more spools akin to the one or more cables 1330 a (shown in theschematic in FIG. 21). In a first actuation mechanism, these cables canserve as end effector cables, such that manipulation of theircorresponding mechanical inputs 1324 causes a change of length of thecables within the handle. In some embodiments, the change of length ofthe one or more cables within the handle can include a change of thepath length of one or more cables or cable segments within the handle.In some embodiments, a path length of the cables within the handle ischanged. In some instances, the change of length in the one or morecables 1330 a′, 1330 a″, 1330 a′″, 1330 a″″ within the handle 1320 thatactuate the end effector is counterbalanced by a length of cable 1330 b,which is akin to the similarly reference cable 1330 b in FIG. 21. Inother instances, under pure end effector actuation, the length of thecable 1330 b in the handle is not changing. In a second actuationmechanism, the cable 1330 b can serve as an insertion cable, such thatmanipulation of its corresponding mechanical input 1324 causes cable1330 b to be wound around the insertion spool 1370 c. The amount ofcable 1330 b that is wound around the insertion spool 1370 c that causesshaft insertion is counterbalanced by a length of the one or more cables1330 a′, 1330 a″, 1330 a′″, 1330 a″″ being unwound.

FIG. 23 illustrates a top perspective view of a handle and shaft of aninstrument, according to one embodiment. The shaft 1202 is translatablerelative to the handle 1220. From this view, one can see the one or moremechanical inputs 1224, which upon rotation, actuate the end effector.In addition, one can see the one or more mechanical inputs 1324, whichupon rotate, allow for translation of the shaft 1202 relative to thehandle 1220 along an axis of insertion. The attachment interface 1222includes the one or more mechanical inputs 1224, 1324 e.g., receptacles,pulleys or spools, that are designed to reciprocally mate with one ormore torque couplers 314 on an attachment interface 310 of the IDM 300(shown in FIG. 3).

FIG. 24A illustrates a schematic view of a cross-section of aninstrument shaft utilizing the insertion architecture shown in FIG. 12,while FIG. 24B illustrates a schematic view of a cross-section of aninstrument shaft utilizing the alternative insertion architecture shownin FIG. 21. While not visible, each of the cross-sections in FIGS. 24Aand 24B include openings or lumens that extend therethrough. As shown inFIG. 24A, the insertion architecture of FIG. 12 results in one or morecables 1230 that extend through grooves or channels 1208 that extendalong an outer surface of the shaft 1202. In contrast, as shown in FIG.24B, the insertion architecture of FIG. 21 results in one or more cables1330 b that extend through less grooves or channels 1308 (here a singlechannel) along an outer surface of the shaft 1202. This is because inthe alternative architecture of FIG. 21, cables are more inclined toextend within the body of the shaft 1302. For example, there are no endeffector cables on the outside of the shaft 1302. With less cablesextending on the outside of the shaft 1302, the architecture in FIG. 21can result in an overall smoother shaft surface with less grooves orchannels extending on an outer surface.

VIII. Embodiments of Insertion Architectures for Specific Instruments

The architectures described above (e.g., shown in FIGS. 12 and 21) canbe used to actuate an end effector and accommodate instrument insertion.In addition, these architectures can be incorporated into specific typesof instruments to assist in surgical procedures.

One such instrument is a vessel sealer. With a vessel sealer, a knife orcutter can be driven through to cut tissue. In some embodiments, motionof the knife is rotational. In other embodiments, motion of the knife istranslational. FIGS. 25-27 show different architectures that can beincorporated into a vessel sealer instrument to drive a knife through avessel sealer. The architectures shown in these figures are like thearchitecture and related mechanisms shown in FIG. 12, but in otherembodiments, the architectures can be like the architecture and relatedmechanisms shown in FIG. 21.

FIGS. 25-27 illustrate schematic diagrams showing differentarchitectures for driving a knife in a vessel sealer. The architecturescreate a differential in path length amongst cables, and turns thisdifferential path length change into linear motion of the knife. In theembodiments in FIGS. 25 and 26, two cables 1430 a, 1430 b are placed incounter tension, while in the embodiment in FIG. 27, a single cable 1430and spring 1490 is used for counter tension. In the embodiments wheretwo cables are placed in counter tension, linear motion of the knife isachieved by having both differentials on the same input axis, but inopposite directions (e.g., one is unwrapping cable while the other iswrapping cable). The dual, opposing cable approach also utilizes aredirect pulley to close the tension loop, and this can be mounted at ornear a proximal end or at or near a distal end of a shaft (shownrespectively in FIGS. 25 and 26). Once you have cable that is beingpulled in and out, the knife can be coupled to a section of cable tocreate an in and out motion of the knife.

FIG. 25 illustrates a schematic diagram showing an architecture fordriving a knife 1482 in a vessel sealer 1480. The architecture comprisesa first cable 1430 a and a second cable 1430 b, wherein the first cable1430 a and second cable 1430 b are in counter tension. The architecturefurther comprises one or more spools or pulley members 1470 a, 1470 b,1470 c that are engaged by the first cable 1430 a, and one or morespools or pulley members 1470 d, 1470 e, 1470 f that are engaged by thesecond cable 1430 b, and a redirect spool or pulley 1470 g that closesthe tension loop. The redirect pulley 1470 g is positioned at or near aproximal portion of the shaft. With the first cable 1430 a and secondcable 1430 b in counter tension to one another, the knife 1482 can becoupled to a section of cable (e.g., first cable 1430 a) via a connectorsuch as elongate member 1484, thereby creating an in and out motion ofthe knife 1482 relative to the vessel sealer 1480. In some embodiments,elongate member 1484 comprises a push rod. In other embodiments,elongate member 1484 withstands the driving compression forces withoutbuckling.

FIG. 26 illustrates a schematic diagram showing an alternativearchitecture for driving a knife in a vessel sealer. The architecture issimilar to that shown in FIG. 25; however, in the present embodiment,the redirect pulley is positioned at or near a distal portion of theshaft.

FIG. 27 illustrates a schematic diagram showing yet another alternativearchitecture for driving a knife in a vessel sealer. Unlike the priorembodiments in FIGS. 25 and 26, the architecture in the presentembodiment utilizes a single cable 1430 that is in counter tension witha spring 1490. The architecture further comprises one or more spools orpulley members 1470 a, 1470 b, 1470 c that are engaged by the firstcable 1430 a. With the cable 1430 in counter tension with the spring1490, the knife 1482 can be coupled to a section of the cable 1430,thereby creating an in and out motion of the knife 1482 relative to thevessel sealer 1480.

Another device that can serve as an insertion instrument is a camera.The camera can be used for endoscopic surgery. The architecture can varydepending on whether the camera is a rigid camera or an articulatingcamera, for which actuation for articulation will have to be provided.

FIG. 28 illustrates a schematic diagram showing an architecture formaking a rigid camera an insertion instrument. The camera 1500 comprisesa distal image payload connected by a shaft 1502 to a camera handle 1530which has interface buttons and a cable coming out of it. The cable 1530is received in a channel or groove formed on the outside of the shaft1502, while the insertion handle 1520 is positioned around the shaft1502. This in effect adds a second handle to the endoscope which enablesinsertion capability. The cable 1530 extends through one or more spools1570 a, 1570 b, 1570 c. In the present embodiment, spool 1570 b can be acapstan. In some embodiments, the capstan can comprise a zero-walkcapstan (as shown in FIG. 17), while in other embodiments, the capstancan allow cable walk (as shown in FIGS. 18 and 19). Via the capstanmechanism, the camera is capable of translation along an axis ofinsertion. In some embodiments, the core payload maintains the samesealing architecture as a rigid scope, so it can be expected to besterilized with the same methods. For a rigid scope, this means it canbe autoclaved. The additional insertion handle 1520 may also look likean instrument from a sterilization perspective and can be autoclaved aswell.

While FIG. 28 shows an architecture for making a rigid camera aninsertion instrument, articulating cameras present additionalcomplexity, as mechanisms would be added to the camera to provide forarticulation. For the articulating camera, one or more cables (e.g.,actuation or wrist cables) can be provided to accommodate articulatingmovement. The camera can also be housed in a sealed area, such that ifone is to run the one or more cables on the outside, one can also createa sealed compartment for the camera that excludes the one or morecables. With this architecture, it may be possible that some particlesand debris get into small spaces within the sealed area. In someembodiments, to prevent the contamination, one solution may be to addtwo articulation motors within the sealed camera area rather thanrelying on the IDM for articulation motion. This greatly simplifies thecleaning and sealing of the camera components by taking the cables fromthe outside of the tube and putting them in the sealed inside. Anotherbenefit of adding the two articulation motors within the sealed camerais that articulation of the camera can be controlled as soon as thecamera is plugged into a vision box. This enables features like keepingthe camera straight during installation or removal and being able toarticulate the camera from the camera handle to look around duringoff-robot use. This then makes the articulation camera look a lot likethe rigid camera from a sterilization perspective such that it ispossible to be autoclaved.

If a camera is not able to be autoclaved, then the sealed camera coreand the insertion section may need to be separated for cleaning andinsertion. This is because it is desirable to autoclave an insertionhandle to achieve reliable sterilization. FIG. 29 shows a firstinsertion architecture that allows a camera to be separated from aninsertion handle, while FIGS. 30 and 31 show a second insertionarchitecture that allows a camera to be separated from an insertionhandle, thereby allowing for better sterilization.

FIG. 29 shows a first insertion architecture that allows a camera to beseparated from an insertion handle. The architecture has an autoclavableinsertion handle 1620 that latches onto an IDM and is separable from thecamera core 1600. The camera core 1600 comprises a shaft 1602 thatextends through the handle 1620. The handle 1620 comprises one or morewires 1630 a, 1630 b that extend through spools 1670 a, 1670 b, 1670 c,1670 d. In the present embodiment, spool 1670 b comprises a capstan. Insome embodiments, the spool 1670 b comprises a leadscrew. In someembodiments, the capstan is a zero-walk capstan (as shown in FIG. 17),while in other embodiments, the capstan allows cable walk. The insertionhandle 1620 can be removably attached to the camera core 1600 via aconnector 1640. In some embodiments, the connector 1640 comprises abracket. In other embodiments, the connector 1640 comprises a verticalplate that the camera latches to. As the insertion handle 1620 isremovably attached to the camera core 1600, each is capable ofseparation for cleaning.

FIGS. 30 and 31 show a second architecture that allows a camera to beseparated from an insertion handle. In the present embodiment, anovertube 1780 is provided that has an insertion cable 1730 attached toit and through which a camera 1700 can be loaded for a procedure. FIG.30 shows the camera 1700 detached and separated from the overtube 1780,while FIG. 31 shows the camera 1700 loaded into the overtube 1780. Toload the camera 1700 into the overtube, a distal tip 1706 and shaft 1702of the camera 1700 passes through the overtube 1780. The overtube 1780is connected to a handle 1720 which houses a spool 1770 in the form of acapstan. This architecture has the benefit of keeping the camera 1700separate from an insertion handle 1720 if desired, so that bothcomponents can be easily cleaned. Furthermore, the camera 1700 is keptlow profile in use, as it is to be fit into the overtube 1780. As theinsertion handle 1720 is removably attached to the camera core 1700,each is capable of separation for cleaning.

FIG. 32 illustrates a diagram showing an alternative architecture forshaft translation, according to another embodiment. In the presentembodiment, the instrument comprises a shaft 1902 having a proximalportion 1904 and a distal portion 1906. Insertion of the shaft 1902 canbe driven by a rack gear 1912 and pinion 1914, wherein rotation of thepinion 1914 results in translation of the rack gear 1912 and the shaft1902 that is coupled to the rack gear 1912. In some embodiments, therack gear 1912 is positioned on the instrument shaft 1902, while thepinion 1914 is positioned within the housing of the instrument handle. Amotor driver can be used to translate the shaft 1902 relative to thehandle. In some embodiments, a spur gear can be used, in addition to acycloid pin rack profile. In some embodiments, the rack gear 1912 andpinion 1914 can be used on its own to cause insertion or translation ofthe shaft 1902. In other embodiments, the rack gear 1912 and pinion 1914can accompany and complement any of the insertion mechanisms describedabove. The rack gear 1912 and pinion 1914 can be used with any of thetypes of instruments described above to provide linear insertion of theinstrument shaft relative to the handle.

IX. Surgical Tool Sealing

When performing surgical procedures, such as laparoscopic procedures,surgeons use insufflation. This means that cannulas inserted into apatient are sealed against the surgical tool shafts to maintain positivepressure inside a patient's body. Seals can be coupled to the surgicaltool shafts to prevent air from leaking from a patient's body. Theseseals are often designed to accommodate tools having roundcross-sections. It can be difficult to apply the same seals to toolshaving non-circular shapes and concave features on the outer surfaces ofthe shaft, as passages formed by these surfaces can allow the release ofair pressure at the tool seal. For example, instruments havinginstrument based insertion architectures can have cross-sections (asshown in FIG. 24A) with grooves 1208 where air can leak from a patient.

To address this challenge, a system including multiple seals can beprovided to prevent air leakage in a patient. In particular, a novelseal can be provided that works with a cannula seal having a circularouter shape, which is customary with instruments having circularcross-sections. The novel seal can pass through the circular cannulaseal, thereby providing a consistent rotary seal. The novel seal wouldadvantageously discretize any rotary and linear motion to create twoboundaries at which a seal is created. The discretization is achieved byhaving an intermediate tool seal piece.

FIG. 33 shows a side cross-sectional view of an instrument havingmultiple seals to prevent air leakage from a patient. FIG. 34 shows afront cross-sectional view of the instrument having the multiple seals.The instrument 1200 is inserted into a cannula 50, and is akin to theinstrument shown in FIG. 11 having an instrument based insertionarchitecture. The instrument can include a shaft 1202 translatablerelative to a handle 1220. The shaft 1202 can have one or more channelsor grooves 1208 extending along an outer surface thereof, therebycreating passages that could allow air to leak from a patient.

To prevent air leakage, a multi-seal system advantageously couples tothe instrument. In some embodiments, the multi-seal system comprises afirst seal 1810 and a second seal 1820 that can work in conjunction toreduce the risk of air leakage. In some embodiments, the first seal 1810and second seal 1820 are coaxial. As shown in FIG. 32, the second seal1820 can be received in an interior of the first seal 1810. The firstseal 1810 can have a cross-section having a round outer perimeter andround inner perimeter, while the second seal 1820 can have across-section having a round outer perimeter and an inner perimeter withinner protrusions, tabs or nubs 1822, as shown in FIG. 34. The advantageof having a second seal 1820 with the inner protrusions is that theinner protrusions can fill in voids, such as grooves 1208, that mayextend along an outside of the instrument shaft 1202, thereby reducingthe risk of air leakage from a patient during surgery.

The multi-seal advantageously discretizes rotary and linear motion tocreate two boundaries at which a seal is created. The second seal 1820,with its inner protrusions 1822, can slide down the outer grooves of theinstrument shaft 1202, thereby creating a sliding linear seal forinstrument shaft motion. One skilled in the art will appreciate thatwhile the second seal 1820 is shown with a plurality of innerprotrusions that are rounded and spaced substantially symmetricallyaround an inner perimeter, the inner portion of the second seal 1820 canassume other shapes as well, so long as the molding processsubstantially matches the interior of the second seal 1820 to the outersurface of the instrument shaft 1202. When received in the grooves 1208of the instrument 1200, each of the inner nubs 1822 of the second seal1820 creates a rotary seal point 1824. These rotary seal points allowthe instrument 1200 and second seal 1820 to rotationally lock and rotatetogether upon rotation of the instrument shaft 1202. While the presentembodiment shows a multi-seal having dual seals, in other embodiments,three, four, or more seals can work together to reduce the risk of airleakage from a patient during surgery.

X. Alternative Considerations

Upon reading this disclosure, those of skill in the art will appreciatestill additional alternative structural and functional designs throughthe disclosed principles herein. Thus, while particular embodiments andapplications have been illustrated and described, it is to be understoodthat the disclosed embodiments are not limited to the preciseconstruction and components disclosed herein. Various modifications,changes and variations, which will be apparent to those skilled in theart, may be made in the arrangement, operation and details of the methodand apparatus disclosed herein without departing from the spirit andscope defined in the appended claims.

As used herein any reference to “one embodiment” or “an embodiment”means that a particular element, feature, structure, or characteristicdescribed in connection with the embodiment is included in at least oneembodiment. The appearances of the phrase “in one embodiment” in variousplaces in the specification are not necessarily all referring to thesame embodiment.

Some embodiments may be described using the expression “coupled” and“connected” along with their derivatives. For example, some embodimentsmay be described using the term “coupled” to indicate that two or moreelements are in direct physical or electrical contact. The term“coupled,” however, may also mean that two or more elements are not indirect contact with each other, but yet still co-operate or interactwith each other. The embodiments are not limited in this context unlessotherwise explicitly stated.

As used herein, the terms “comprises,” “comprising,” “includes,”“including,” “has,” “having” or any other variation thereof, areintended to cover a non-exclusive inclusion. For example, a process,method, article, or apparatus that comprises a list of elements is notnecessarily limited to only those elements but may include otherelements not expressly listed or inherent to such process, method,article, or apparatus. Further, unless expressly stated to the contrary,“or” refers to an inclusive or and not to an exclusive or. For example,a condition A or B is satisfied by any one of the following: A is true(or present) and B is false (or not present), A is false (or notpresent) and B is true (or present), and both A and B are true (orpresent).

In addition, use of the “a” or “an” are employed to describe elementsand components of the embodiments herein. This is done merely forconvenience and to give a general sense of the invention. Thisdescription should be read to include one or at least one and thesingular also includes the plural unless it is obvious that it is meantotherwise.

What is claimed is:
 1. A medical device, comprising: a shaft comprisinga proximal portion and a distal portion; an end effector connected tothe distal portion of the shaft; and a handle coupled to the shaft andconfigured to be releasably coupled to a robotic arm, wherein the shaftis configured to, in use, translate relative to the handle.
 2. Themedical device of claim 1, further comprising: a first actuationmechanism configured to actuate the end effector; and a second actuationmechanism configured to translate the shaft relative to the handle,wherein the first actuation mechanism is decoupled from the secondactuation mechanism.
 3. The medical device of claim 2, wherein the firstactuation mechanism includes a first cable that extends through a firstset of pulleys, wherein manipulation of at least one pulley of the firstset of pulleys causes a change of length of the first cable within thehandle, thereby causing actuation of the end effector.
 4. The medicaldevice of claim 3, wherein the second actuation mechanism includes asecond cable that engages a spool, wherein manipulation of the spoolcauses the shaft to translate relative to the handle.
 5. The medicaldevice of claim 4, wherein the change of length of the first cablewithin the handle to cause actuation of the end effector is not affectedby manipulation of the spool that causes the shaft to translate relativeto the handle.
 6. The medical device of claim 3, wherein the first cableof the first actuation mechanism extends from the proximal portion ofthe shaft, through the first set of pulleys and to the distal portion ofthe shaft.
 7. The medical device of claim 6, wherein manipulation of theat least one pulley of the first set of pulleys to cause a change oflength of the first cable within the handle comprises linear or rotarymotion of the at least one pulley.
 8. The medical device of claim 3,wherein the first actuation mechanism is configured to permit freemovement of the shaft relative to the first set of pulleys.
 9. Themedical device of claim 4, wherein the spool comprises a zero-walkcapstan.
 10. The medical device of claim 9, wherein rotation of thesecond mechanical input causes rotation of the zero-walk capstan. 11.The medical device of claim 2, wherein the first actuation mechanismincludes one or more cables that extend through a first set of pulleys,and the second actuation mechanism includes one or more cables and aninsertion spool, wherein at least one of the one or more cables of thefirst actuation mechanism terminates on the insertion spool.
 12. Themedical device of claim 11, wherein the one or more cables of the firstactuation mechanism comprise end effector cables and the one or morecables of the second actuation mechanism comprise insertion cables. 13.The medical device of claim 11, wherein rotation of the secondmechanical input causes rotation of the insertion spool thereby causingtranslation of the shaft relative to the handle.
 14. The medical deviceof claim 12, wherein the one or more cables of the second actuationmechanism are pre-tensioned such that frictional force can be used todrive the one or more cables of the second actuation mechanism.
 15. Amedical system, comprising: a base; a tool holder coupled to the baseand comprising an attachment interface; a robotic arm between the baseand the tool holder; and an instrument, comprising: a shaft comprising aproximal portion and a distal portion, an end effector extending fromthe distal portion of the shaft, and a handle coupled to the shaft, thehandle including a reciprocal interface releasably attachable to therobotic arm via the attachment interface, wherein the shaft isconfigured to, in use, translate relative to the handle.
 16. The medicalsystem of claim 15, wherein the instrument further comprises a firstactuation mechanism configured to actuate the end effector; and a secondactuation mechanism configured to translate the shaft relative to thehandle, wherein the first actuation mechanism is decoupled from thesecond actuation mechanism.
 17. The medical system of claim 16, whereinthe first actuation mechanism includes a first cable that extendsthrough a first set of pulleys, wherein manipulation of at least onepulley of the first set of pulleys causes a change of length of thefirst cable within the handle, thereby causing actuation of the endeffector, and wherein the translation of the shaft relative to thehandle is performed via the second actuation mechanism that includes asecond cable that engages a spool, wherein manipulation of the spoolcauses the shaft to translate relative to the handle.
 18. The medicalsystem of claim 17, wherein the change of length of the first cablewithin the handle to cause actuation of the end effector is not affectedby the manipulation of the spool that causes the shaft to translaterelative to the handle.
 19. The medical system of claim 18, whereinmanipulation of the at least one pulley of the first set of pulleys tocause a change of length of the first cable within the handle compriseslinear or rotary motion of the at least one pulley.
 20. The medicalsystem of claim 16, wherein the first actuation mechanism is configuredto permit free movement of the shaft relative to the first set ofpulleys.
 21. A non-transitory computer readable storage medium havingstored thereon instructions that, when executed, cause at least onecomputing device to: control a robotic arm to manipulate an instrumentthrough an incision or natural orifice of a patient to perform aprocedure at a surgical site, wherein the instrument comprises: a shaftincluding a proximal portion and a distal portion; a handle coupled tothe shaft and configured to be releasably coupled to the robotic arm;and an end effector extending from the distal portion of the shaft; andcontrol the shaft to translate relative to the handle.
 22. Thenon-transitory computer readable storage medium of claim 21, wherein theinstrument includes a first actuation mechanism for actuating the endeffector and a second actuation mechanism for translating the shaftrelative to the handle, wherein the first actuation mechanism comprisesa first set of pulleys and a first cable and the second actuationmechanism comprises a spool and a second cable.
 23. The non-transitorycomputer readable storage medium of claim 22, further having storedthereon instructions that, when executed, cause at least one computingdevice to: manipulate the end effector via the first actuationmechanism.
 24. The surgical method of claim 23, further having storedthereon instructions that, when executed, cause at least one computingdevice to: translate the shaft via the second actuation mechanism,wherein the first actuation mechanism is decoupled from the secondactuation mechanism.
 25. A non-transitory computer readable storagemedium having stored thereon instructions that, when executed, cause atleast one computing device to: control a robotic arm to guide aninstrument through a portion of a patient's anatomy to perform aprocedure at a surgical site, wherein the instrument comprises: a shaftincluding a proximal portion and a distal portion, a handle coupled tothe shaft and configured to be releasably coupled to the robotic arm,and an end effector extending from the distal portion of the shaft; andcontrol the end effector to cause the shaft to translate relative to thehandle.
 26. The surgical method of claim 25, wherein the instrumentincludes a first actuation mechanism for actuating the end effector anda second actuation mechanism for translating the shaft relative to thehandle, wherein the first actuation mechanism comprises a first set ofpulleys and a first cable and the second actuation mechanism comprises aspool and a second cable.
 27. The surgical method of claim 26, furtherhaving stored thereon instructions that, when executed, cause at leastone computing device to: manipulate the end effector via the firstactuation mechanism.
 28. The medical device of claim 1, wherein thehandle comprises an actuation mechanism configured to translate theshaft relative to the handle.